Physician's Killing Prompts Changes, Reflection

You wouldn't even notice the new safety precautions
at my practice, and you probably don't know about the bad things that happened
in my medical community that necessitated them. But I know those new safety
measures are there, and the recent additions make me feel a little bit safer
than I did a few months ago.

There are new locks on the doors between the waiting
room and the area that leads to our exam rooms, and other changes are under consideration.

Here I'm reviewing electronic health records with medical assistant
Jessica Martinez. Events in our community have made me think about what my practice can do to keep staff and patients safe.

I always thought of my practice as a safe place
where people could come for help, and where I, in turn, would "do no
harm." But it turns out that violence can happen anywhere. And sometimes
it comes to us, as it did for my community back in December.

After the dust had settled, we found out that a
disgruntled patient had entered a local urology clinic and told everyone in the
waiting area to get out. The man, who blamed a vasectomy for his failing
health, then walked through an unlocked door between the waiting room and the
exam rooms and opened fire with a 12-gauge shotgun. When it was over, one
physician was dead and another was seriously injured. A relative of a patient
visiting the clinic also was injured before the shooter took his own life.

When we discovered who had been killed and who had
been injured, we were shocked and speechless. These were not only colleagues,
they were friends and mentors.

The incident affected our community far beyond the
walls of the medical building where the shootings took place. For example, the
wife of the physician who died is an obstetrician who works downstairs in my
building. She has two teenage children.

In the aftermath, patients were wary of coming to
appointments at the urology clinic. Some patients couldn't even go into the building
where the shootings had happened.

Both my brother- and sister-in-law are police
officers here in Reno, Nev., and they often point out that things like this can
happen anytime, anywhere. They get up in the morning, put on their bulletproof
vests and are pretty much prepared for anything.

Me? I put on scrubs and a stethoscope and prepare to
help people who need it. Never would I have previously gone to work thinking
that my patients or I would be at risk for such a tragedy. How do we feel safe
-- and make our patients feel safe -- in an increasingly violent society?

A few weeks before the shooting at the urology
clinic, a 12-year-old boy brought his parents' gun to school in a neighboring
town and killed a teacher and wounded two students before killing himself.

A month after the shooting at the urology clinic, an
elderly man entered a hospital in Carson City -- our state capital -- and shot
and killed his wife in what was planned as a murder-suicide. His gun jammed.

Violence seems to lead to more violence. After the
attacks on the local urologists, other physicians in our community received
threats from patients. One man who was denied narcotics by a physician at my
practice took it way too far. First, he called in threats. When that didn't get
the response he wanted, he made more threats in person. The police were called,
and he was arrested.

Incidents like these make me realize that we
physicians deal with issues of safety and mortality in more ways than one. It
also made me step back and evaluate how experiences shape the way we practice.
Are there physicians who now are more lenient in their prescribing practices
because of threatening patients? Are there physicians who have changed the way
they perform surgery?

Was something lacking in the communication between
the disgruntled patient and his physicians? Now I make even more of an effort
to listen to both the spoken and unspoken concerns of my patients. I have
tried, along with my colleagues, to rebuild the sense of security within my
office and our medical community that was shattered this past winter. The
physical changes to our clinic are just a small change that helped me and my
staff go back to our normal everyday lives.

What is your practice doing to keep its physicians,
staff and patients safe?

Helen
Gray, M.D., is an employed family physician in Reno, Nev., working in a
hospital-based setting. She also is adjunct faculty with the University of
Nevada School of Medicine. You can follow her on Twitter @helengraymd.

Dear Dr. Gray,
I am sorry for what you, your colleagues, your staff, and your patients have been through. You ask what is your office and staff doing to keep itself safe? Our organization tries to address this through an annual test but it is only superficially dealt with. I agree with the proactive approach you mention. A shotgun can be hard to conceal so I wonder if someone saw something unusual that day but did not speak up. Perhaps encouraging staff you work with to not be afraid to speak up or sound a warning if they see something unusual. I imagine you and others you work with have asked themselves a thousand times if they could have done something different that day. A lot of second guessing is common after a tragedy like this or a disaster. Unfortunately a determined person with no conscious who is intent on causing harm is nearly impossible to stop so nobody should blame themselves. Guards at entrances with metal detectors might have prevented this event inside the building but a determined person would have planned an ambush in the parking lot or somewhere else. Some people would say outlaw guns but the assailant could have used any number of other weapons or means to inflict harm. Be vigilant. Be careful.
My Sympathies,
John Sherard

Hi John! What kind of annual test do you guys do? The idea of a metal detector had been thrown around however its sad to think that that has to be an option to consider. I agree that we have had to educate our staff to take every threat seriously at this point. It definitely felt like a violation of our communities safety within walls that provide healing.

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